Buprenorphine for human immunodeficiency virus/hepatitis C virus-coinfected patients: does it serve as a bridge to hepatitis C virus therapy?

Objectives: Buprenorphine is associated with enhanced human immunodeficiency virus (HIV) treatment outcomes including increased antiretroviral therapy initiation rates, adherence, and CD4 cell counts among HIV-infected opioid-dependent individuals. Buprenorphine facilitates hepatitis C virus (HCV) treatment in opioid-dependent patients with HCV monoinfection. Less is known about buprenorphine's role in HIV/HCV coinfection.

Integrating HCV services for drug users: a model to improve engagement and outcomes.

Although the majority of prevalent and incident cases of hepatitis C are related to injection drug use, drug users often find it difficult to access treatment services because of concerns about adherence and treatment candidacy. In response to the growing epidemic, OASIS, a nonprofit community clinic, developed a successful peer-based HCV group that allowed us to engage, educate, test, and treat hepatitis C in large numbers of drug users, the majority of whom have multiple potential barriers to intervention. Integrating services for hepatitis C, addiction, mental health, and psychosocial problems, the model involves a collaboration of medical providers and peer educators and incorporates elements of other proven behavioural models, including self-help groups, therapeutic communities, and peer interventions.

Adherence to hepatitis C treatment in recovering heroin users maintained on methadone.

Objectives: Injection drug users are often denied hepatitis C (HCV) treatment due to concerns about adherence, despite limited data about the impact of such common issues as psychiatric illness and intercurrent drug use. We sought to define the impact of these and other potential adherence barriers in a real-world sample of recovering drug users.

Methods: We conducted a prospective observational study of 71 methadone-maintained patients who received interferon and ribavirin combination therapy in a community-based clinic with expertise in treating addictive disorders.

Cannabis use improves retention and virological outcomes in patients treated for hepatitis C.

Objectives: Despite the widespread use of polypharmacy, the management of hepatitis C virus (HCV) treatment-related side-effects is often incomplete, and many patients turn to cannabis for symptom relief. Unfortunately, there are few data about cannabis use on treatment outcomes, leaving clinicians without the data needed to inform recommendations.

Methods: To define the impact of cannabis use during HCV treatment, we conducted a prospective observational study of standard interferon and ribavirin treatment in 71 recovering substance users, of whom 22 (31%) used cannabis and 49 (69%) did not.

Approaching treatment for hepatitis C virus infection in substance users.

Although injection drug users represent the majority of incident and prevalent cases of hepatitis C, most lack access to treatment because of concerns about adherence, treatment efficacy, and reinfection. On the basis of an increasing body of evidence suggesting that injection drug users can successfully undergo treatment for hepatitis C virus (HCV) infection, the 2002 National Institutes of Health Consensus Statement on Hepatitis C has recommended that substance users, even those with ongoing drug use, be considered for treatment for HCV infection on a case-by-case basis. However, the criteria on which these treatment decisions should be based are unclear: The duration of pretreatment drug abstinence, comorbid psychiatric illness, intercurrent drug use, and the potential for injected interferon to cause relapse of drug use may all influence results of treatment for HCV infection.

The impact of barriers to hepatitis C virus treatment in recovering heroin users maintained on methadone.

Although most cases of hepatitis C virus (HCV) infection are associated with injection drug use, there are few data regarding the impact of putative barriers such as psychiatric disease and intercurrent drug use on HCV treatment outcomes. To define the impact of characteristics often cited as reasons for withholding HCV treatment, we studied HCV treatment in a real world sample of 76 recovering heroin users maintained on methadone. Overall, 21 (28%) had a sustained virological response and 18 (24%) discontinued treatment early.

Treating hepatitis C virus infection in active substance users.

Although injection drug users represent the majority of new and existing cases of infection with hepatitis C virus (HCV), many lack access to treatment because of concerns about adherence, effectiveness, and reinfection. On the basis of on a small but increasing body of evidence showing that injection drug users can undergo treatment for HCV infection successfully, the 2002 National Institutes of Health Consensus Statement on Hepatitis C has recommended that substance users be treated for HCV infection on a case-by-case basis. However, the criteria on which these treatment decisions should be made are unclear.

Co-occurring Hepatitis C, substance use, and psychiatric illness: treatment issues and developing integrated models of care.

Hepatitis C virus (HCV) infection is transmitted by injection drug use and associated with psychiatric conditions. Patients with drug use or significant psychiatric illness have typically been excluded from HCV treatment trials noting the 1997 National Institutes of Health Consensus Statement on HCV that indicated active drug use and major depressive illness were contraindications to treatment of HCV infection. However, the 2002 NIH Consensus Statement recognized that these patients could be effectively treated for HCV infection and recommended that treatment be considered on a case-by-case basis.

The utility of indirect predictors of hepatitis C viremia.

Objective: Although the majority of injection drug users (IDUs) have been exposed to hepatitis C (HCV), only 60-85% remain chronically viremic and at risk for HCV-induced progressive liver damage or transmitting HCV to others. Access to direct viral testing to establish the presence or absence of viremia is limited due to its expense. This study of 500 current and former IDUs examines the utility of demographic and biochemical features as a means of indirectly predicting HCV viremia.

Treating hepatitis C in methadone maintenance patients: an interim analysis.

Objective: This study evaluates the safety, tolerability, and efficacy of interferon/ribavirin combination therapy in methadone maintenance (MM) patients with active hepatitis C (HCV). End-of-treatment results are presented as an interim analysis of efficacy.

Methods: Fifty eligible MM patients with active HCV and concomitant liver fibrosis were treated with interferon/ribavirin combination therapy using standard dosing regimens.